Medical apparatus



l. B. KRONENBERG MEDICAL APPARATUS A ril 20, 1937.

Original Filed Oct. 24, 1935 the nasal passages.

Patented Apr. 20, 1937 PATENT OFFICE MEDICAL APPARATUS Isaac Bert Kronenberg, Baltimore, Md.

Application October 24, 1933, Serial No. 695,021 Renewed September 24, 1936 2 Claims.

This invention relates to medical treatments and apparatus and particularly to such treatments and apparatus for irrigating and medicating various mucous membranes and draining nasal sinuses.

It is a general object of the present invention to provide a novel and improved method of and apparatus for irrigating and treating mucous membranes, particularly those in' connection with More particularly it is an object of the present invention to provide a novel method of and apparatus for treating and draining nasal sinuses by irrigating the mucous membranes of the nasal passages with a liquid under controlled delivery pressure and removal suction whereby a minimum of difference between the atmospheric pressure and the pressure within the nasal passages exists so that a considerable quantity of liquid can be passed through the nasal passages without subjecting them to positive or negative pressures of any great extent.

Important features of the invention reside in the method as well as the construction of the apparatus whereby means are provided to adjust the head or pressure of the liquid flowing to the nasal passages as well as the quantity and wherein means are provided to adjust the suction used for removing the used irrigating liquid.

Other and further features and objects of the invention will be more apparent to those skilled in the art upon consideration of the accompanying drawing and following specification, wherein is disclosed a single exemplary embodiment of the invention, with the understanding, however, that such changes, variations and modifications may be made therein as fall within the scope of the appended claims without departing from the spirit of the invention.

In said drawing:

The single figure illustrates the apparatus as used to carry out the method of the present invention.

In the treatment of diseases of the nasal passages, and particularly the nasal sinuses, various methods have been suggested and used. Most of them comprise the application of irrigating liquids either with or without supplementary suetion treatment, but sometimes the suction treatments are used alone in an efiort to withdraw from the sinuses the irritating mucous fluids and pus accumulations.

These sinuses open into the nasal passages through extremely small openings and are otherwise closed, so that the use of suction, either steady or pulsating, in an effort to withdraw accumulations through these small openings results in a very considerable irritation of the soft nasal tissues, sometimes even causing them to bleed, and produces a secondary irritation and congestion which defeats the very purpose for which the treatment is given. Such treatments are now no longer favored by leading nose and throat specialists.

Those treatments which use an irrigating liquid along with a suction are subject to the same disadvantages, the presence of the liquid only serving to carry away any excretions which are drawn out by the suction. Classed with such processes and apparatus are those wherein the liquid used 'for irrigating, and passing from one nostril to the other, is lifted from a container by the suction which causes it to pass through the nasal passages.

The application of liquids in the form of douches accompanied by a definite amount of positive pressure is required where suction is not resorted to in order to deliver sufficient fluid to wash from the infected surfaces whatever secretions may be thereon. Such use of irrigating liquids not only fails in its desired purpose but often causes detrimental results as by forcing foreign substances and infected mucus into the sinuses as well as into the Eustachian tubes leading into the cars.

In accordance with the present invention the irrigating liquid is caused to flow through the nasal passages under substantially neutral conditions, i. e. no positive or negative pressure except that necessary to cause a sufficient quantity of liquid to flow to perform the desired results. The operation of the present invention depends for its effectiveness on the aspirating action of the flowing liquid on the sinuses, for it flows at substantially right angles to the direction of the passages into the sinuses and thus exerts a very gentle suction tending to remove excretions from the sinuses without irritating the surrounding tissues. Accompanying this gentle pressure reduction is an efiect attributed to surface tension, for on contacting the mucous material within the sinus openings with the liquid flowing by in the nasal passages there is an attraction and the moving liquid tends to continue to withdraw from the openings the material which it is desired to remove even though that material may be of a more viscous consistency.

The method according to the present invention comprises first a treatment of the nasal mucous membranes with a material intended to shrink them so as to cause Contraction of the tissues around the openings into the sinuses and enlarge these openings to better facilitate the free passage of the secretions from them. As an example of a material suitable for this, purpose may be mentioned ephedrine, a drug well-known in thetreatment of diseases of the mucous membranes of the nose and throat. This material may be applied either as a spray or by direct contact with cotton on an applicator.

The second step comprises the irrigation-suction treatment {wherein a suitable medicated liquid is directed into one nostril, passes through the nasal passages and is removed from the other nostril, and wherein the liquid is caused to flow with substantially balanced pressure so that the effect is solely from the flow of the liquid and not from differences in pressure. This treatment may be continued first in one direction and then in the other for a period considered most favorable by the attending physician or by the patient. On the completion of this operation the liquid is allowed to drain from the nasal passages without blowing the nose and as a final or finishing treatment the mucous membranes are sprayed or otherwise treated with a medicinal oil vapor which is introduced through the nostrils and comes out through the mouth, clinging to the mucous membranes and gradually forming a thin, pleasing, protective film which exerts a tonic effect on the tissues. Various materials of this type are known for similar use.

The apparatus for carrying out the above treatment is disclosed in the drawing. It includes a pair of nozzles I0 and 12 which may be independent or permanently secured together, as desired, each having a suitable tip for insertion into a nostril-so as to completelyclose the nostril to prevent any leakage of liquid out or air in. These nozzles are held one in each hand of the patient and properly inserted into the nostrils while the patient sits on a chair of suitable height with the head leaning well forward as shown inthe drawing. The patient keeps the mouth open and breathes through it and is instructed to avoid swallowing during the treatment. During the treatment it is important to maintain the nasal passages isolated from the throat. The soft palate forms anatural valve for the passage connecting these parts and is closed for instance when the letter K is being pronounced. This letter, however, cannot be pronounced continuously, so the procedure used by certain doctors in treating the nasal passages of having the patients say K, K, K is not satisfactory. The position assumed by the patient with the head well forward in accordance with the instructions provided with the equipment herein described automatically causes a soft palate to fall to a position for closing the passage between the throat and the nose. If a mereirrigation were attempted under these conditions, however, the weight of the water in the nasal passages would be suificient to push open the soft palate and allow leakage into the throat which would not only be unpleasant to the patient, but would render the treatment ineffective, for there would not be the same out-flow from one nostril as in-flow through the other and the aspirating effect of a large 'quantity of liquid flowing by the sinus openings would be lost. The low vacuum applied to the second nostril in accordance with the presentinvention maintains just a sufiiciently reduced pressure in the nasal passages to overbalance the weight of the liquid therein so that the soft palate is maintained in its closed position, providing a complete and isolated nasal passage compartment for the treatment.

One of the nozzles I2 is connected by a flexible tube M to a suitable reservoir such as the bottle l5 having the bottom outlet l6, and on this tube is a clamp 11 adapted to completely shut 01f the fiow and an adjustable clamp I8 adapted for regulating the rate of flow. The nozzle I0 is connected by a tube 20 to the entrance pipe 2| into the receptacle 22. A second pipe 23passes out through the tightly fitting cork of the receptacle and. is connected by a tube 2d to the combined vacuum-gauge and regulator 25 which has the regulating knob 26 thereon. From this combined unit the tube 2! leads to a source of suction which may be either the usual physicians vacuum pump or a suitable aspirator.

The receptacles, which may be quite similar bottles, [5 and 22 are conveniently mounted on supporting brackets 28, 29 which, are carried on a rod 30 to which is also attached the vacuum gauge and pressure regulator. Extending from this unit are the convenient hangers 3| for the nozzles when not in use. This rod 30 is adapted to telescope within a tubular standard 32 mounted on a suitable tripod base 33 and there is a clamping screw 34 for locking it in adjusted position.

By having the two bottles at substantially the same height, which is adjustable in relation to the height of the patients head, it will be seen that there can be a flow. by gravity from the bottle l5 to the nasal passages and substantially back to the bottle 22 without theapplicationof any suction and that only sufficient suction is needed to make up for the difference in height of the liquids in the two bottles and to provide suflicient pressure unbalance to producean adequate quantity of flow of the liquid from the bottle; I 5. I

The rate of flow of the liquid can to a large extent be regulated by the height of the bottle 5 above that of the patients head which produces the positive pressure. This determines the rate of flow but where it is sometimes desirable to increase the positive pressure slightly the rate of flow may then be regulated by the adjusting clamp l8.. p

The receptacle 22 is provided to receive the discharge from the mucous membranes as well as the liquid from the container I5 so as to prevent clogging of the regulator 26 or the vacuum pump. The adjusting knob 26 is used for regulating the amount of suction which is indicated on the dial and serves to insure a minimum of pressure. To prevent accidental application of too much suction there is combined in the unit 25 a relief valve set for a very low vacuum.

It will be seen that with the apparatus just described treatment can beeffected with substantially no positive or negative pressure diiferences between the nasal passages and the atmosphere, so that the effect of thetreatment is substantially solely from the flow of the liquid, although, if desired, by proper adjustment of the devices 18 and 26 and the height of the bottles above the patients head some suction can be applied or even positive pressurewhere conditions may warrant it in the judgment of the treating physician. The apparatus is all convenientlygrouped on a single portable stand taking very little floor space and requires only the customary physicians vacuum pump or water suction pump for its operation.

The arrangement of the apparatus on the stand permits particularly eifective supervision of the treatment by the operator. The two bottles are grouped closely together and at a convenient height for observation. The operator by watching them can determine the rate of flow of liquid from the reservoir and the rate of delivery of liquid 5 to the suction bottle and if he notes a difierence in these rates, he knows that there is a leakage and that all of the medicated liquid is not being efiectively used, so that he can immediately stop the operation by pinching the two tubes l4 and 10 20 and seek the cause of the trouble. The vacuum gauge being mounted just below the bottle is at the same time in his field of vision and he can maintain a careful watch to be sure that the vacuum is adequate and not so great as to be 15 detrimental. The adjustment in height of the standard permits variations in the hydraulic head of the liquid used for the treatment, while the clamp on the delivery tube for this liquid permits regulation of the rate of flow independent of 20 this head. The combination of the vacuum regulator and vacuum gauge in a single unit provides maximum convenience and effectiveness of operation.

Having thus described the invention, what is 5 claimed as new and desired to be secured by Letters Patent is:

1. The method of treating nasal sinuses comprising, applying a shrinking medium to the nasal mucous membranes to shrink the tissues around the sinus openings, then delivering an irrigating liquid to one nostril, removing the liquid from the other nostril and so adjusting the delivery positive pressure, the removal negative pressure and the rate of liquid flow as to maintain a substantially neutral pressure within the nasal passages.

2. In a device for irrigating the nasal sinuses, in combination, a standard, a reservoir and a receptacle each detachably mounted near the upper end of the standard, means to adjust the standard to regulate the height of the reservoir, a nozzle adapted for insertion tightly into one nostril, a tube attached near the bottom of the reservoir and adapted to deliver irrigating liquid by gravity to said nozzle, means to regulate the rate of flow to said nozzle, a second nozzle for insertion into the other nostril, a tube connecting said second nozzle to said receptacle, a tube for connecting said receptacle to a source of suction, a suction gauge mounted on said standard adjacent said receptacle and connected to indicate the degree of vacuum therein, and a vacuum regulating device to adjust the degree of suction applied to the second nozzle.

ISAAC BERT KRONENBERG. 

